How to treat Helicobacter pylori - first-line, second-line, and future therapies

Numerous trials were performed in the 1990s to define the optimal therapy f or Helicobacter pylori infections. The proposed proton-pump inhibitor (PPI) -based and ranitidine bismuth citrate (RBC)-based triple therapies led to s atisfactory results. Their first drawback is cost, and, for this reason, ma ny people worldwide cannot benefit from these regimens. Failures of first-l ine therapies essentially are because of antimicrobial resistance, which in creases with the selection pressure resulting from the use of these drugs. Second-line treatments using antimicrobial agents for which H. pylori resis tance is low or nonexistent are being tested to find alternatives to the qu adruple therapy. There is a need for new drugs, which should be highly effe ctive, nonselective of resistant strains, and without side effects, to impr ove current regimens. These drugs may be the results of postgenomic studies .